title: Exogenous surfactant therapy in 2013: what is next? Who, when and how should we treat newborn infants in the future?
abstract: BACKGROUND
  Surfactant therapy is one of the few treatments that have dramatically changed clinical practice in neonatology. In addition to respiratory distress syndrome (RDS), surfactant deficiency is observed in many other clinical situations in term and preterm infants, raising several questions regarding the use of surfactant therapy.
  
  
  OBJECTIVE
  This review focuses on several points of interest, including some controversial or confusing topics being faced by clinicians together with emerging or innovative concepts and techniques, according to the state of the art and the published literature as of 2013. Surfactant therapy has primarily focused on RDS in the preterm newborn. However, whether this treatment would be of benefit to a more heterogeneous population of infants with lung diseases other than RDS needs to be determined. Early trials have highlighted the benefits of prophylactic surfactant administration to newborns judged to be at risk of developing RDS. In preterm newborns that have undergone prenatal lung maturation with steroids and early treatment with continuous positive airway pressure (CPAP), the criteria for surfactant administration, including the optimal time and the severity of RDS, are still under discussion. Tracheal intubation is no longer systematically done for surfactant administration to newborns. Alternative modes of surfactant administration, including minimally-invasive and aerosolized delivery, could thus allow this treatment to be used in cases of RDS in unstable preterm newborns, in whom the tracheal intubation procedure still poses an ethical and medical challenge.
  
  
  CONCLUSIONS
  The optimization of the uses and methods of surfactant administration will be one of the most important challenges in neonatal intensive care in the years to come.
authors.affiliation: Réanimation et Pédiatrie Néonatales, Groupe Hospitalier Robert Debré, APHP, 48 Bd Sérurier, Paris, 75019, France. olivier.baud@rdb.aphp.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lopez
authors.forename: Géraldine
authors.initials: G
authors.lastname: Gascoin
authors.forename: Cyril
authors.initials: C
authors.lastname: Flamant
authors.forename: Mona
authors.initials: M
authors.lastname: Merhi
authors.forename: Pierre
authors.initials: P
authors.lastname: Tourneux
authors.forename: Olivier
authors.initials: O
authors.lastname: Baud
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D015931:Intensive Care, Neonatal / Q000379:methods* / Q000639:trends; D008171:Lung Diseases / Q000188:drug therapy*; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy*
chemical_list: D011663:Pulmonary Surfactants